Is lumber puncture effective for idiopathic intracranial hypertension and papilledema?
Hi Doctor.. I have been diagnosed with idiopathic intracranial hypertension and papilledema. I have been advised to get lumber puncture and few other procedures done before starting the actual treatment, perhaps a surgery is needed is what i'm told. I was wondering if the condition can be treated without any invasive procedures.could you please let me know what's the best course of treatment? Also, would Ayurvedic or Homeopathic can be considered for this? I have undergone a heart surgery as a child and i'm really worried about another surgery or lumber puncture procedures. Any suggestions much appreciated.
Brief Answer: Medications would help.
Detailed Answer: Hi,
Thank you for posting your query.
I have noted your symptoms and diagnosis.
Presence of papilledema with normal MRI and venogram of brain is highly suggestive of IIH (idiopathic intracranial hypertension i. e. raised intracranial pressure).
Lumbar puncture is done to quantify the cerebro-spinal fluid (CSF) pressure and exclude infection in the CSF.
Treatment may be started without lumbar puncture also, however, it is useful to know the CSF pressure before we start the treatment.
Initial treatment of IIH is with medications such as diamox (acetazolamide) and steroids (prednisolone).
Only when the medications do not cause improvement, a shunt surgery is done to lower the CSF pressure.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, XXXXXXX XXXXXXX Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in
Acetazolamide helps to reduce increased eye pressure.
If you feel sleepy after taking the tablets/capsules, do not drive or use tools or machines until you feel better.
There are a number of common side-effects, but they are not usually serious.
About acetazolamide
Type of medicine
A carbonic anhydrase inhibitor
Used for
Glaucoma
Also called
Diamox®; Diamox® SR
Available as
Tablets and modified-release capsules
An increase in pressure within your eye can lead to damage to the optic nerve at the back of your eye. When this occurs it is called glaucoma. Glaucoma can lead to a loss of vision if it is not treated. Treatment with acetazolamide helps to reduce eye pressure, and this helps to prevent further eye damage. You will also be given other medicines to help reduce the pressure in your eyes, commonly as eye drops.
Acetazolamide works by blocking the action of an enzyme called carbonic anhydrase. Blocking this enzyme reduces the amount of fluid that you make in the front part of your eye (called aqueous humour), and this helps to lower the pressure within your eye.
Acetazolamide is sometimes prescribed for other conditions which are not covered by this leaflet. If you have been prescribed it to remove excess water from your body, or to help treat epilepsy, speak with your doctor if you need further advice.
Before taking acetazolamide
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking acetazolamide it is important that your doctor knows:
If you are pregnant or breast-feeding.
If you have liver or kidney problems, or difficulty passing urine.
If you have sugar diabetes.
If you have breathing problems.
If you have problems with your adrenal glands, such as Addison's disease.
If you have been told you have low amounts of potassium or sodium, or high levels of acid in your blood.
If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
If you have ever had an allergic reaction to a medicine. It is particularly important that you tell your doctor if you are allergic to sulfonamide antibiotics.
How to take acetazolamide
Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The manufacturer's leaflet will give you more information about acetazolamide and a full list of the side-effects which you may experience from taking it.
Your doctor will prescribe you a dose that is suited to your condition, so take acetazolamide exactly as your doctor tells you to. If you are taking tablets, it will be between 1-4 tablets daily, taken in divided doses over the day. If you are taking capsules, it will be 1 or 2 capsules daily. Your dose will be printed on the label of your pack to remind you what your doctor said.
If you are taking capsules (brand Diamox® SR), they are specially formulated to release the medicine they contain slowly during the day to give a more even effect. Do not chew or open the capsules as this will stop them from working as intended.
Try to take your doses at the same times of day each day, as this will help you to remember to take acetazolamide regularly. You can take your doses either just before or just after meals.
If you forget to take a dose, take it as soon as you remember unless your next dose is due. If your next dose is due, then take the dose which is due but leave out the forgotten one. Do not take two doses together to make up for a missed dose.
Getting the most from your treatment
Keep your regular appointments with your doctor so that your progress can be monitored.
Your doctor will tell you how long you will need to take acetazolamide for. It is not generally recommended for long-term use, so if you need to take it over an extended period of time, your doctor will want you to have some blood tests. You should also let your doctor know if you develop an unusual skin rash while you are on acetazolamide.
If you buy any medicines, check with a pharmacist that they are safe to take alongside acetazolamide.
If you are having an operation or any medical treatment, remember to tell the person carrying out the treatment which medicines you are taking or using.
Can acetazolamide cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with acetazolamide. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.
Common acetazolamide side-effects
What can I do if I experience this?
Feeling sleepy, tired or dizzy
Do not drive or use tools or machines until you feel better
Upset stomach, feeling sick, diarrhoea
Stick to simple meals. Try taking the tablets after meals if you are not already doing so
Headache
Ask your pharmacist to recommend a suitable painkiller
A metallic taste, lack of appetite, looking flushed, feeling irritable, feeling thirsty, tingling feelings, passing urine more often
If any of these become troublesome, speak with your doctor
If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist for further advice.
How to store acetazolamide
Keep all medicines out of the reach and sight of children.
Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
British National Formulary; 66th Edition (September 2013) British Medical Association and Royal Pharmaceutical Society of Great Britain, London
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Treating certain types of glaucoma, epilepsy, or edema (fluid buildup) in combination with other medicines. It is also used to treat or prevent symptoms of mountain sickness. It may also be used for other conditions as determined by your doctor.
Acetazolamide is a carbonic anhydrase inhibitor. It reduces fluid pressure in the eyeball by decreasing fluid formation in the eyeball. It also increases the removal of water from the body by the kidney. It also may block certain nerve discharges that may contribute to seizures.
Do NOT use acetazolamide if:
you are allergic to any ingredient in acetazolamide
you have adrenal gland problems, low blood levels of potassium or sodium, kidney problems, liver problems (eg, cirrhosis), high blood levels of chloride, or other electrolyte problems
Contact your doctor or health care provider right away if any of these apply to you.
Some medical conditions may interact with acetazolamide. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have kidney stones, a lung disease, glaucoma (eg, chronic non-congestive angle-closure glaucoma), diabetes, or difficulty breathing
if you have had a severe allergic reaction (eg, a severe rash, hives, breathing difficulties, or dizziness) to any other sulfonamide medicine such as acetazolamide, celecoxib, certain diuretics (eg, hydrochlorothiazide), glyburide, probenecid, sulfamethoxazole, valdecoxib, or zonisamide
Some MEDICINES MAY INTERACT with acetazolamide. Tell your health care provider if you are taking any of the following medicines:
Salicylates (eg, aspirin) because they may increase the risk of acetazolamide's side effects
Other carbonic anhydrase inhibitors (eg, methazolamide), cyclosporine, quinidine, phenytoin, amphetamine, or sodium bicarbonate because the risk of their side effects may be increased by acetazolamide
Primidone, salicylates (eg, aspirin), lithium, or methenamine because their effectiveness may be decreased by acetazolamide
This may not be a complete list of all interactions that may occur. Ask your health careprovider if acetazolamide may interact with other medicines that you take. Check with yourhealth care provider before you start, stop, or change the dose of any medicine.
How to use acetazolamide:
Use acetazolamide as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Take acetazolamide by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
Drinking extra fluids while you are taking acetazolamide is recommended. Check with your doctor for instructions.
Acetazolamide may increase the amount of urine or cause you to urinate more often when you first start taking it. To keep this from disturbing your sleep, try to take your dose before 6 pm.
If a dose is missed, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use acetazolamide.
Important safety information:
Acetazolamide may cause drowsiness or temporary vision changes. These effects may be worse if you take it with alcohol or certain medicines. Use acetazolamide with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
Acetazolamide may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to acetazolamide. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.
Tell your doctor or dentist that you take acetazolamide before you receive any medical or dental care, emergency care, or surgery.
Acetazolamide may interfere with certain lab tests. Be sure your doctor and lab personnel know you are taking acetazolamide.
Diabetes patients - Acetazolamide may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.
Lab tests, including blood electrolyte levels, complete blood cell count, or platelet levels, may be performed while you use acetazolamide. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
Use acetazolamide with caution in the ELDERLY; they may be more sensitive to its effects.
Acetazolamide should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.
PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using acetazolamide while you are pregnant. Acetazolamide is found in breast milk. Do not breast-feed while taking acetazolamide.
Possible side effects of acetazolamide:
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:
Blurred vision; changes in taste; constipation; diarrhea; drowsiness; frequent urination; loss of appetite; nausea; vomiting.
Seek medical attention right away if any of these SEVERE side effects occur:
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blood in urine; changes in hearing; convulsions; dark, bloody stools; dark urine; fast breathing; fever; lack of energy; lower back pain; red, swollen, or blistered skin; ringing in the ears; sore throat; tingling of the arms or legs; unusual bleeding or bruising; vision changes; yellowing of the skin or eyes.
This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.
If OVERDOSE is suspected:
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your localpoison control center, or emergency room immediately. Symptoms may include abnormal skin sensations (eg, tingling, tickling, itching, burning); buzzing, ringing, or whistling in the ears; drowsiness; loss of appetite; loss of coordination; nausea; tremors; unsteady movements; vomiting.
Proper storage of acetazolamide:
Store acetazolamide at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep acetazolamide out of the reach of children and away from pets.
General information:
If you have any questions about acetazolamide, please talk with your doctor, pharmacist, or other health care provider.
Acetazolamide is to be used only by the patient for whom it is prescribed. Do not share it with other people.
If your symptoms do not improve or if they become worse, check with your doctor.
Check with your pharmacist about how to dispose of unused medicine.
This information should not be used to decide whether or not to take acetazolamide or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about acetazolamide. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to acetazolamide. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using acetazolamide.
Review Date: February 1, 2016
Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.
